Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus.

L Handscomb,G W Shorter,D J Hoare,D A Hall

doi:10.1186/s12955-016-0524-5

Abstract

BackgroundPeople with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.MethodsThe CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from ‘not a problem’ to ‘a very big problem’. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.ResultsThe best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus ‘not a problem’, and ‘a small problem’ or ‘a moderate problem.’ConclusionThis study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0524-5) contains supplementary material, which is available to authorized users.

Highlights

People with troublesome tinnitus often experience emotional distress
Participants The data analysed in this study were obtained from 342 adults experiencing tinnitus who were recruited from National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit (BRU) volunteer database, the British Tinnitus Association (BTA) member magazine, ‘Quiet’, and social media sites run by the BTA and the charity Hearing Link
The complex, higher-order models proposed by Lyne et al [32] and Skre et al [33] were not tested in this study. They were shown to be well fitting, these models are impractical for clinical use because they do not allow individual factor scores to be calculated and the purpose of this study is to offer guidance on how the CORE-OM might best be used by clinicians who wish to obtain a score and/ or sub-scores reflective of emotional distress amongst their tinnitus patients

Summary

Introduction

People with troublesome tinnitus often experience emotional distress. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience. There is a greater association between symptoms of generalised anxiety and depression and tinnitus distress than there is between these symptoms and perceived tinnitus loudness [6], and negative emotional state has been shown to be a partial mediator between tinnitus loudness and tinnitus distress [9]. Tinnitus may be perceived as loud but not annoying by people who are not depressed [10] These findings suggest that emotional distress plays an important role in determining people’s tinnitus experience, independently from loudness of sound

Objectives

Methods

Results

Discussion

Conclusion